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SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA
KNOWLEDGE AND BARRIERS TO CONTRACEPTIVE USE AMONG IN-SCHOOL
ADOLESCENT IN ADAKLU DISTRICT
BY
RICHMOND AGBANYO
(10637685)
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF
MASTER OF SCIENCE IN APPLIED HEALTH SOCIAL SCIENCE DEGREE
JULY, 2018
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DECLARATION
I hereby declare that, except for references to other people's work which has been duly acknowledged, this work is the result of an independent work done by me under supervision. I further declare that it has neither in whole nor part been submitted for any degree in this University or elsewhere.
…………………………….. ………………………………
RICHMOND AGBANYO DR. COLLINS AHORLU
(STUDENT) (ACADEMIC SUPERVISOR)
DATE………………………. DATE………………………
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ACKNOWLEDGEMENT
This work could not have been possible without the unfailing grace, strength, wisdom and direction from the Almighty God. I, therefore, thank the Almighty God for making this work a success.
I wish to put on record my profound gratitude to my academic supervisor, Dr Collins Ahorlu,
Noguchi Memorial Institute for Medical Research (NMIMR), the University of Ghana for his unstinting supervision, in the entire work.
My appreciation also to my parent Mr Johnny Agbanyoh and Mrs Rose Goka for their support.
My sincere appreciation also goes to all lecturers and staff of the School of Public Health who in diverse ways contributed to creating a congenial learning environment throughout this program of study.
I am sincerely thankful to my research assistants, Mr Seth Agbanyo and Miss. Nora Oppong for their assistance in the field work of this project.
I would like to thank the District Education Service in Adaklu and headmasters for their cooperation and support during the data collection.
I am extremely grateful to the respondents who gave their consent to participate in this study.
In the conduct of this study, I received a lot of suggestions and encouragement from many individuals and I hereby register my indebtedness to them all.
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TABLE OF CONTENTS
ACKNOWLEDGEMENT ...... ii
TABLE OF CONTENTS ...... iii
LIST OF FIGURES ...... vi
LIST OF TABLES ...... vii
OPERATIONAL DEFINITION ...... ix
ABSTRACT ...... x
CHAPTER ONE ...... 1
INTRODUCTION...... 1 1.1 Background to the Study ...... 1 1.2 Problem Statement ...... 3 1.3 Justification ...... 4 1.4 Research Questions ...... 5 1.5 General Objectives ...... 5 1.6 Specific Objectives ...... 6 1.7 Conceptual Framework ...... 6
CHAPTER TWO ...... 10
LITERATURE REVIEW ...... 10 2.1 Introduction ...... 10 2.2 The Concept of Contraception ...... 10 2.3 Types and Methods of Contraception ...... 12 2.4 Knowledge of contraceptive use among adolescent ...... 12 2.5 Prevalence of Contraceptive Use Among Adolescents ...... 14 2.6 Barriers to Contraceptive Use ...... 15
CHAPTER THREE ...... 25
METHODOLOGY ...... 25 3.1 Introduction ...... 25
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3.2 Study Design...... 25 3.3 Study Area ...... 25 3.4 Study population ...... 26 3.5 Inclusion and Exclusion Criteria ...... 26 3.5.1 Inclusion Criteria ...... 26 3.5.2 Exclusion Criteria ...... 26 3.6 Variables of the Study ...... 26 3.6.1 Dependent Variables ...... 26 3.6.2 Independent Variables ...... 27 3.7 Sampling...... 27 3.7.1 Sample Size Estimation ...... 27 3.7.2 Sampling Procedure ...... 28 3.8 Pretest ...... 29 3.9 Data Collection Techniques ...... 29 3.10 Data Processing and Analysis...... 29 3.11 Quality Control ...... 30 3.12 Ethical Issues ...... 31
CHAPTER FOUR ...... 32
RESULT...... 32 4.1 Introduction ...... 32 4.2 Socio-Demographic Characteristics of Respondent ...... 32 4.3 Contraceptive Knowledge of Respondents ...... 34 4.4 Knowledge of Contraceptives and Socio-Demographic Characteristics ...... 35 4.5 Current contraceptive use among in-school adolescent ...... 36 4.6 Contraceptive use and demographic characteristics ...... 38 4.8 Barriers to Non-Use of Contraceptives Contraceptive ...... 40
CHAPTER FIVE ...... 42
DISCUSSION OF FINDINGS ...... 42 5.1 Introduction ...... 42 5.2 Knowledge of Contraceptive Use ...... 42 5.3 Prevalence of Contraceptive Use ...... 44 5.4 Barriers to Contraceptive Use ...... 47
CHAPTER SIX ...... 49
CONCLUSION AND RECOMMENDATION ...... 49
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6.1 Conclusion ...... 49 6.2 Recommendation ...... 50 6.3 Limitation ...... 50
REFERENCES ...... 51
APPENDICES ...... 61
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LIST OF FIGURES
Figure 1-1 Conceptual Framework ...... 9
Figure 4-1 Ever Used Contraceptives ...... 37
Figure 4-2 Barriers to Contraceptive Use ...... 41
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LIST OF TABLES
Table 4-1Socio-Demographic Characteristics of Respondents ...... 33
Table 4-2Knowledge of Respondents on Contraceptives ...... 35
Table 4-3 Knowledge of contraceptives and Socio-Demographic Characteristics ...... 36
Table 4-4 Prevalence of Contraceptive Use ...... 38
Table 4-5 Current Contraceptive Use and Socio-Demographic Characteristics ...... 39
Table 4-6 Regression Analysis and Contraceptive Use ...... 40
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LIST OF ABBREVIATIONS
WHO: World Health Organization
UNICEF: United Nation Children Fund
HIV: Human Immune Virus
AIDS: Acquired Immune Deficiency Syndrome
STDs: Sexually Transmitted Diseases
STIs: Sexually Transmitted Infections
UNDPA: United Nation Department of Political Affairs
GDHS: Ghana Demographic Health Survey
SDG: Sustainable Development Goal
IUD: Intrauterine Device
GHS: Ghana Health Service
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OPERATIONAL DEFINITION
Contraceptives: These are devices, methods, and techniques used to prevent STDs and pregnancy from occurring.
Use of Contraceptive: use of any method of contraceptive at least once during sexual life.
Knowledge of contraceptive: defined as the ability of an adolescent to know about contraceptive methods.
Adolescent: The concept of adolescence is difficult to define across different socio-cultural setting and profession; for the purposes of this study adolescence is defined as age group 12-19 years.
In school adolescents: these adolescents aged 12-19 attending regular Senior High School and
Junior High School during the time of the survey.
Barriers to contraceptives: these are factors that hinder contraceptive usage.
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ABSTRACT
Background: Non-use of contraceptive have received a global recognition, but despite the danger of an unwanted pregnancy and sexually transmitted disease adolescent rarely use contraceptives.
Promoting contraceptive use among adolescent has become a major challenge even though it has proven to reduce maternal and child mortality, teenage pregnancy and STDs. In spite of it, enormous benefit contraceptive uptake among adolescent still remains low.
Objective: The main objective of the study is to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district.
Methods: This was a cross-sectional study design using quantitative research tools. The systematic random sampling procedure was used to recruit 280 in-school adolescent age 12-19 years. Data from the administered questionnaire was analyzed using SPSS version 23 with a 95% confidence interval and a p-value of 0.05.
Result: The study found that the knowledge of contraceptive use among in-school adolescent is high 88%, but only 18% knew more than two methods of contraception. Prevalence of contraceptive use was 18%. A binary logistics regression revealed that only traditional religion
(P=0.038) was significantly associated with contraceptive use compared to Christians.
The major barrier to contraceptive use was fear of side effect, afraid of being seen by a parent, cost of procuring contraceptives, religion and lack of knowledge on how to use contraceptive properly.
Conclusion: There should be a collaboration between the ministries of health and education to promote all-inclusive education on contraception to help adolescent take control over and improve their lives.
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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Non-use of contraceptive have received global recognition, but despite the dangers of an unwanted pregnancy and sexually transmitted diseases, adolescents rarely use contraceptives (Kinaro,
Kimani, Ikamari, & Ayiemba, 2015). Unplanned pregnancy has become a key issue in medical, social and public health. Globally 40% of all pregnancies are unwanted and these are attributed to non-use of contraception (WHO, 2014). It is asserted that unwanted and unsafe abortion can be prevented by expanding family planning services and also tackling the disadvantaged groups such as sexually active teenagers (WHO, 2014). The adolescent is a critical period of the years between the onset of puberty and social independence (Curtis, 2015).
There is an increase in adolescents population globally, it is estimated that there is about 1.2 billion adolescent in the world (Unicef, 2011). The United States has the highest unwanted pregnancy in the world (James-Hawkins & Broaddus, 2016). Out of 6.6 million pregnancies in the United States fifty-one percent were unplanned (Finer & Zolna, 2014). According to Finer & Zolna, (2014) unintended pregnancy can be reduced by addressing basic socio-economic factors and increasing condom use. The only sure way of preventing unwanted pregnancy is through effective use of contraceptive (James-hawkins & Broaddus, 2016). However, James-hawkins & Broaddus, (2016) identified nervousness, population growth, low socioeconomic status, religious orientation, cost, access to services, and lack of insurance coverage as barriers to contraceptive use. According to
Kamau et al., (1996) 245 out of 248 whoever use contraceptive had some form of challenges.
Knowledge and use of contraceptive have a pivotal role in preventing consequences such unwanted pregnancy and abortion than the failure to use contraceptive (Makhaza & Ige, 2014). When
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adolescent leaves parental supervision, they find themselves among their peers and in an event where the tide of peer pressure becomes very strong and therefore had to depend on peers for information and advice because parent finds it difficult to discuss sex with them, these leads to misinformation and misconception (Makhaza & Ige, 2014). Adolescents also gets information from the article, videos, magazines, books, and internet, and study shows that most of this information is misleading and leads to practices which expose adolescents to predicaments such as teenage pregnancy and sexually transmitted diseases like HIV/AIDS, syphilis, and gonorrhea
(Makhaza & Ige, 2014). It is estimated that 90% of sexually active adolescent have knowledge on contraceptive but these knowledge does not lead to contraceptive usage (Kamau et al., 1996).
Among sexually active adolescents 61.4% out of school and 57.5% in school have ever used contraceptives, however, 28.6% and 49.3% out school and in school respectively did not use contraceptives consistently (Kamau et al., 1996).
In sub-Saharan Africa, Kenya has 98% records on contraceptive knowledge but 19.6% below the age of 20 use contraceptives and 36% gives birth before their twentieth birthday (Kinaro et al.,
2015).
Most studies in Ghana show that most adolescents are aware of at least one modern contraceptives, however contraceptive use is limited (Fannam, Phil, Adja, & Adjei, 2014). Contraceptive uptake among adolescents is low with 19.5% and 14.7% for females and males respectively despite the high knowledge (Kinaro et al., 2015). Non-use of contraceptive results in unwanted pregnancy and acquisition of diseases like STIs which mess up an adolescents’ life by hindering their education, good health, and future employment. (Fannam et al., 2014).
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1.2 Problem Statement
Decision making to use contraceptive and other reproductive services involves a complex interaction of individual and his or her environment. Unintended pregnancy among adolescents is becoming a huge public health concern not only in Ghana but also in the world. Globally, in 2015 alone, 15.3 million adolescents had unintended pregnancies and it is estimated that when the current trend continues without anything being done about it, it will increase to 19.2 million in
2035. Demand for contraceptive generally have increased drastically but still remarkably lower in this age group (UNDPA, 2016). Majority of these unplanned pregnancies ends up with a high rate of unsafe and illegal abortion (WHO, 2014).
The adolescents have a high incidence of unplanned pregnancy partly due to non-use of contraceptives and deviations. It has been reported that 50% of adolescents with unintended children did not use any contraception during sex (Coles, Makino & Stanwood, 2011). The use of contraceptive has a great tendency of protecting teenagers from sexually transmitted diseases and unplanned pregnancies (Makhaza & Ige, 2014).
Contraceptive use is important in preventing unintended pregnancies, illegal abortion and other complications among adolescents which exposes them to health-related problems like infertility and death in some cases (Mahama & Owusu-agyei, 2014).
In Sub Saharan Africa, sexually transmitted diseases and teenage pregnancy rates are high and efforts to promote the use of contraceptives among teenagers who are most sexually active has not achieved much as it was intended (Makhaza & Ige, 2014). A study conducted in Uganda found that sexually active students do not have access to contraceptives and reproductive health services and programs despite their high knowledge in contraceptives (Nsubuga, Sekandi, Sempeera &
Makumbi, 2015).
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The 2014 Ghana Demographic Health Survey indicates that 5.6 million Ghanaians are adolescents and out of this figure, 564000 are sexually active and had sex in the last 90 days. The mean age of an adolescent who had sex before age 20 is 16.8 years and 16.7 years for males and females respectively. Also, 89.9% of the sexually active adolescents do not want to give birth, but 27.5% of them were not using any form of contraceptive (GDHS, 2014a).
The contraceptive rate in Volta region is 32.2% and teenage pregnancy is 22.1% being the highest in Ghana. Volta region also recorded the second lowest (37.4%) in any form of knowledge in preventing sexually transmitted diseases (GDHS, 2014b). Teenage pregnancy in Adaklu is alarming, in 2014 out of five antenatal registrants one was an adolescent, in 2015 out of four registrants one was an adolescent and in 2016 out of six registrants, one was an adolescent
(Gosanet Foundation, 2017). These unwanted pregnancies lead to force or early marriage, homelessness, school dropout, rejection and death.
In spite of the increasing rate of teenage pregnancy in the Adaklu district, not much work had been done to find out why adolescents are sexually active but do not use contraception. This research work seeks to investigate the knowledge and barriers of contraceptives use among in-school adolescents in the Adaklu district.
1.3 Justification
Using various methods of contraception in family planning has been found to bridge the gender equality gap as well as promote educational and economic empowerment for adolescents (Apanga
& Adam, 2015). Generally, there is a wide gap between what adolescent know about contraceptive and its use. This study is important because despite a study conducted in central region indicating high knowledge on adolescent reproductive health and contraceptive use,(Hagan & Buxton, 2012)
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much has not been documented on the barriers that hinder contraceptive use among adolescents.
Increasing contraceptive use among sexually active adolescent’s population has the tendency of reducing significantly unwanted pregnancies, STDs and abortion which will eventually lead to a reduced in maternal and infant mortality. The findings of this work will also help policymakers and programme managers of the specific areas worthy of consideration in the implementation of programmes for an adolescent. Furthermore, the information gathered would add to existing knowledge in academia and research on the contraceptive use and related issues. The finding will contribute data that could be useful for designing of an intervention to promote contraceptive use among adolescents at both local and national levels. The study will also help bridge the paucity of knowledge on the barriers to contraceptive use among adolescents and help drive the agenda of the Sustainable Development Goals three target one, three and seven in Adaklu district and the country as a whole.
1.4 Research Questions
1. Do in-school adolescents in Adaklu district know about contraceptives?
2. What is the prevalence of contraceptive use among in-school adolescent in Adaklu
district?
3. What are the barriers to the use of contraceptives among in-school adolescents in Adaklu
district?
1.5 General Objectives
To investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district.
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1.6 Specific Objectives
1. To assess the knowledge of contraceptives among in-school adolescents in Adaklu district.
2. To determine the prevalence of contraceptive use among in-school adolescents in Adaklu
district.
3. To identify barriers to contraceptive use among in-school adolescents in Adaklu district.
1.7 Conceptual Framework
The study adopts the health belief model which was first used by a psychologist in the field of
Public Health in the 1950s. The theory was developed as a resulting shortfall in tuberculosis health screening program. This model has since been used to investigate health behaviours, including sexual risk behaviours and HIV/AIDS transmission as well as contraceptives use. The Health
Belief Model is valued expectancy theory and is based on certain core assumptions. This is because before a new behaviour is put up it is first considered if it is valuable. For instance, it is grounded on the assumption that an individual will take up a behavior (i.e., use contraceptives) if that person feels that a negative health consequences (i.e. unwanted pregnancy leading to maternal morbidity and mortality and STDs) can be avoided, (2) has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using contraceptives will be effective at preventing unwanted pregnancy and STDs), and its consequences; and (3) believes that he/she can successfully take a commended health action (i.e., he/she can use the desired contraceptive method comfortably and with confidence). The key variables of the Health Belief
Model are based on perceived susceptibility, perceived severity, perceived benefits, perceived barriers, the cue for action and self-efficacy (Rosenstock et al, 1988).
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Perceived susceptibility, this is when an individual considers the probability of having a health- related condition. This is the individual belief of contracting a disease but feels that the condition can be prevented then develops an interest in overcoming the negative health behaviour (Orji,
Vassileva, & Mandryk, 2012). When the individual perceived that he/she is vulnerable, and not using contraceptive will lead to teenage pregnancy or sexually transmitted disease, he /she will be motivated to take action to avoid the risk. Often the higher the perceived risk the likelihood that the individual will develop a behaviour that will decrease the risk.
Perceived severity is the seriousness an individual attaches to the danger of risk behaviour (Hall,
2012). This is based on the individuals own assessment of the medical, social and economic consequences. When an individual believes that not using contraceptive during sexual intercourse will mean quitting schooling and lose the opportunity of getting a good job in the future, he/she is more likely to develop a behaviour that will help reduce the risk. In terms of STDs, the individual looks at the stigma of having syphilis, gonorrhoea, HIV or AIDS and the challenges he/she will go through will inform the decision of forming a new behaviour to avoid the health outcome associated with non-use of contraception.
Perceived barriers are the individual's perception of the difficulties associated with adopting a new health behaviour (Orji et al., 2012). This also looks at the negative consequences of using contraception (Hall, 2012). When people have side effects like weight gain or mood swing when they use a contraceptive, this could prevent them from using it further. The cost involves getting the required methods can also become a hindrance to formulating a behaviour to minimize negative outcome. The inconvenience of remembering to take pills before or after sexual intercourse may also affect its use. Limited access to obtaining prescriptions for some of the methods such as the
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intrauterine device, the distance to the nearest facility, the attitude of the health workers may also serve as barriers (Hall, 2012).
The perceived benefit, this is the belief or subjective view of the importance or usefulness of developing a health behaviour to offset the perceived risk (Orji et al., 2012). In terms of contraception use, when there is the belief that using it will help avoid unwanted pregnancy and avoid contracting STDs. So, despite the inconvenience, the cost and the side effect that comes with it, the individual may believe that using contraception will better place him or her at a safer side than not using it and this will help them move towards developing a behaviour of using contraceptives.
Cue to action is both internal and external factors that trigger the awareness of a threat (Hall, 2012).
Self-efficacy believes in oneself to be able to put up a behaviour. For instance, if someone believes that using a condom is useful, but does not think that he/she is capable of using it, chances are that he/she will not try the new behaviour (Orji et al., 2012).
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Conceptual framework knowledge and barriers to contraceptive use using the health belief model
Perceived susceptibility Self-efficacy -Unwanted pregnancy Perceived -Ability to use severity -STDs contraceptive Consequences s of unwanted
pregnancy and STDs
Contraceptive use Cue to action Perceived -Internal barrier
stimuli -Side effect - External -Cost stimuli – Insufficient - knowledge -Inconvenience -Access
Perceived benefit
-Complete schooling /acquire a
job -Avoid teenage pregnancy - Avoid STIs – marriage before children.
Figure 0-1 Conceptual Framework
(Rosenstock et al, 1988)
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CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter looks at various works done by others that are related to this study. This is grouped under sub-headings; looking at contraception at the global level, sub-Saharan Africa, and Ghana.
The study is on the contraceptive knowledge and barriers among in-school adolescents. Types of contraceptives were also looked at, knowledge on contraceptives, the prevalence of contraceptive among adolescents and barriers to contraceptives use were discussed.
2.2 The Concept of Contraception
Contraception is a method or devices, agents, sexual practices, drugs, or surgical procedures to prevent pregnancy or sexually transmitted diseases such as syphilis, HIV/AIDS, and gonorrhoea
(WHO, 2011). They are mostly discussed as fertility control methods (WHO, 2011).
Contraceptives are classified into two broad headings; artificial contraceptive methods such as condoms, IUDs, implant and pills, and natural methods such as abstinence and withdrawal. The contraceptive is accepted worldwide because of its importance to couples and individuals to attain their basic right of deciding without any coercion which method to use when they want to protect and prevent themselves from sexually transmitted disease and unwanted pregnancy and taking responsibility of their decision. Contraceptive has become a household name due to its growing acceptance. This is because it does not only enable one to take control over their health determinant but has also improved some social determinant of health such as education income inequalities especially in the marginalized and vulnerable group. (Canning & Schultz, 2012).
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Contraceptive use and reproductive health issues have assumed a topical issue worldwide in many health care settings across the world, and this is as a result of the increasing global acceptance and concern about population maternal increasing, and child mortality, particularly in developing nations (Appiah-Agyekum & Kayi, 2013). Egede et al., (2015), argued that unwanted pregnancy has negative consequences for adolescents, particularly for those in developing countries. It is projected that nearly 210 million pregnancies occur every year globally, with 80 million (38%) being untimed and 46 million (22%) ending in abortion. Further research shows that the contraceptive prevalence rate of a country has a direct relationship with the maternal mortality rate
(Egede et al., 2015).
The use of contraceptive is however seen as a dependable way of regulating population increase, reducing maternal and child death, preventing unplanned pregnancies and future induced abortions as well as improving the social determinant of developing of countries (Apanga & Adam, 2015).
Hence, the Ghana Health Service (GHS) holds the view that increasing the acceptor rate of contraceptives in planning families will lead to an improvement in the lives of adolescents (Apanga
& Adam, 2015). Contraceptive use is much dependent on the individual and these can be as a result of the persons perception and socioeconomic condition which makes one adopt contraceptive use willingly, upon the basis of knowledge, attitudes and responsible decisions by individuals, in order to promote their health and welfare and thus contribute effectively to the social development of a country (Prachi, Das, Ankur, Shipra, & Binita, 2008).
Omideyi et al., (2011), reported that the extent of consistent use of contraceptive by sexually active adolescents shows their preparedness to prevent unwanted pregnancies and induced abortion.
Hence when adolescents use contraceptive this suggest fewer unplanned pregnancies and abortions. Other papers have indicated that India, was the first country to implement a family
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planning program globally (Anjum, Durgawale, & Shinde, 2014). The program promoted contraceptive use through social marketing principles such as television, radio, and prints, flyers’ and billboards campaigns dissemination of information, education and communication with a goal of controlling population growth (Anjum et al., 2014).
Ghana also took the lead in Sub-Saharan Africa to campaign and initiate family planning activities, although political palatalization and partisan politics continue to overwrite national programs. Notwithstanding that, efforts have been made by the Government of Ghana and non- governmental organizations through the formulation and implementation of various programs to make sure that they reduce unmet needs in the country, Although some progress has been seen over the years still there are barriers hindering the awareness and use of contraceptives in the country, the Ghana Demographic and Health Survey observed that the unmet need for family planning still remains high (Curtis, 2015).
2.3 Types and Methods of Contraception
Contraceptives have been partition into two types, modern and traditional methods (Appiah-
Agyekum & Kayi, 2013). The modern type of contraceptive comprises of the pill, intrauterine device, injectables, spermicide, condoms, female and male sterilization and Norplant while the traditional type takes into account abstinence or rhythm, withdrawal and folk methods and calendar method (Appiah-Agyekum & Kayi, 2013).
2.4 Knowledge of contraceptive use among adolescent
Generally, contraceptive knowledge in Ghana among adolescents is very high, about 89% of the adolescents had some form of knowledge on one contraceptive method or the other. Majority of the respondents mention male condom as the type of contraceptive known (84.0%). Other forms
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of contraceptive apart from condom was low, with pills 31.4%, injection 25.5% and emergency contraceptives 5.6%. Also comparing female to males, it was found out that knowledge of contraceptives was high in males 92.1% than in females 86.6%. Comparing also by years it was found that adolescents in 15-17-year-old had least knowledge compared to 18-19-year-old with
85.3% versus 94.4% respectively. Knowledge of at least one contraceptive method was high among adolescents who had education beyond junior high school 97.4% compared to adolescents who had only primary/junior high 87.5% education (Mahama & Owusu-agyei, 2014). This is confirmed in another study which found that knowledge about contraceptives is widespread
96.6%, but in this study, only 22.1% of the adolescents had knowledge in female condoms
(Nsubuga, Sekandi, Sempeera, & Makumbi, 2016).
According to Nyarko, (2015) female adolescents who have knowledge on their menstrual cycle has a higher tendency of using any form of contraception as compared to their counterpart who has no knowledge on how they ovulate. He further suggested that if females know their menstrual cycle they are able to use contraceptive methods that are appropriate. According to the Ghana
Demographic Health Survey (GDHS), in 2014 the awareness of contraceptive among adolescent aged 15-19 was 92.5% (GDHS, 2014a). A current study conducted among senior high school students shows that 81% of adolescent have knowledge in at least one method of contraceptive, with a condom being the highest (Hagan & Buxton, 2012). In a study in four African countries
Ghana, Malawi, Uganda and Burkina Faso, it was found that sex education exposes adolescents to knowledge about contraceptives and the use of contraceptives. Students who had some form of education in school showed that they use contraceptives because they know they were susceptible, compare to their peers who had no education on contraceptives (Bankole, et al., 2007). Practically teaching students how to use contraceptives in school have a positive outcome for the students.
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Male students who are taught how to use contraceptives were likely to use a condom during sexual encounter compared to their counterpart who had no education (Bankole, et al., 2007). A study carried out in South Africa showed that teenagers who got pregnant explained that their lack of knowledge on which contraceptive method to use caused them to be pregnant (Lebese, et al.,
2015). Having a right source of information on contraceptives and how to use it is an important advancement towards the use of contraceptives during a sexual encounter (Khan & Mishra, 2008).
A gap existed between the knowledge that students have on contraceptive use and the actual use,
Hagan & Buxton, (2012), conducted a study in selected schools in Central region found out that, though few students have knowledge in contraceptives 18.7%, 48% of sexually active students said they engage in sexual activity without the use of contraceptives always.
2.5 Prevalence of Contraceptive Use Among Adolescents
Contraceptive prevalence globally is 64%, however, contraceptive use in developing countries is still not doing so well with 40% and was particularly low in developing countries with 33%.
Contraceptive prevalence in other regions is much higher as compared to Africa in 2015, ranging from 59 percent in Oceania to 75 percent in Northern America within these major areas there are large differences by region (United Nations, 2015).
Prevalence in 2015 was high in Northern Africa and Southern Africa with 53 percent and 64 percent, respectively, Middle Africa 23 percent and Western Africa 17 percent. Prevalence of contraceptive had increased in recent times in Eastern Africa and now stands at 40 percent. At the other extreme, Eastern Asia had the highest prevalence 82 percent of all the world regions in 2015, due to the very high level of contraceptive use in China 84 percent. In the other regions of Asia, the average prevalence was in a range between 57 percent and 64 percent (United Nations, 2015).
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Contraceptive prevalence is very low in Ghana. According to Ghana demographic health survey contraceptive prevalence among adolescent was 19% (GDHS, 2014b). Another study conducted among adolescent in the Central Region of Ghana reported a prevalence rate of 21% among adolescents in secondary school. Also, adolescents’ females in Ghana had very low contraceptive prevalence. Contraceptive prevalence among women aged 18 to 19 was 18.3 with modern contraceptive methods being 14.6% and traditional contraceptive method is 3.7%. Increasing in age was associated with contraceptive use. It was found that those aged 18 to 19 had prevalence
31.4% as against 9.2% for those in 15 to 17. Contraceptive use was also found to be high among adolescents with formal education,19.9% than those without any formal education, 3.5% (Nyarko,
2015). Another study among female undergraduate students in two universities in Tanzania reported that out of 70.4% of the participants were sexually active only 41.5% were using contraceptives (Somba, Mbonile, Obure, & Mahande, 2014a). Another study among reproductive- age women reported a prevalence rate of 30.8% (Jabeen, Gul, Wazir, & Javed, 2012).
A cross-sectional study on the use of contraceptives among adolescents in Kintampo indicated that
88.9% of adolescents were sexually active had use one methods of contraceptives active and the prevalence of contraceptive use was 22.1% (Boamah et al., 2014).
2.6 Barriers to Contraceptive Use
Adolescent’s particularly unmarried face a number of barriers to acquiring contraception and using them correctly and consistently. These barriers are factors related to the individual, the immediate environment and the wider environment.
Many studies done in Sub-Sahara Africa indicate that there are many barriers that prevent the use of contraceptives among adolescents. These barriers include; poor knowledge of contraceptive,
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fears and about the future side effect, influences of partners and family member (Williamson,
Parkes, Wight, Petticrew, & Hart, 2009). In a study done among adolescents found that the commonest barriers to contraceptive use were professed health risk, including effects on menstruation, weight and future fertility. Other barriers were mistrust in contraceptives, ambivalent pregnancy intentions, doubt about the future, and partner’s desire for pregnancy and limited access to contraceptives (Chernick et al., 2015).
A study conducted in Ghana that looked at predators to contraceptives use among adolescents showed that age has no relationship with contraceptive use among adolescents. They also found out that educational level, ethnicity and economic nature of adolescents has no relationship with contraceptive use. However, they found a significant association between adolescents who are married and contraceptive use and whether adolescents live in the rural or urban community also had a significant association with contraceptive uses (Marrone, Abdul-Rahman, De Coninck, &
Johansson, 2014).
In a study among adolescents in Uganda, it was found that adolescents who were not in a relationship were not using any form of contraceptives as compared to those in relationships.
However, there was statistical significance between ages of adolescents, male and female and contraceptive use. Also, there was a statistical relationship between age, the area of growing up, and the educational level of the household head, and contraceptive use. Moreover, the place where adolescents lived also had influenced contraceptive use. (Mehra, Agardh, Petterson, & Östergren,
2012).
Ngome and Odinmewu found that adolescent’s age, marital status, and parity and whether they live in urban or rural communities have an impact on the use of contraceptives. However, it was
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realized that education, access to media and economic status does not impact on contraceptive use
(Ngome & Odimegwu, 2014).
An adolescent from aged 15-19 years is more matured and likely to use contraceptive because they are more exposed to information, have easy access to any method of contraceptives. Whereas those between the ages of 10-14 years may not have it easy using contraceptives because it is assumed that at their age they should not have anything to do with sex that will trigger them to use contraceptives for any protection or whatsoever. Besides, adolescents between the ages of 15-19 are likely to be working, married and possibly have attained a more educational level, and more likely to be sexually active than their younger counterparts (Nyarko, 2015).
Adolescents who had a formal education are more likely to use contraceptive compared to those who had no formal education(Nyarko, 2015). However (Khan, Hossain, & Hoq, 2017) found out that in Bangladesh adolescents who did not go to school are less likely to use contraceptives, while studies in Ghana (Nketiah-Amponsah, Arthur, & Aaron, 2012) suggest that the higher a person’s educational level the higher the chance of using contraceptives and they postulated that this is because education has the potential of emancipating from ignorance exposing them to types of contraceptive which impact positively in their lives.
Knowledge of contraceptives among adolescent is important in promoting contraceptive use. A good knowledge of the different types or methods of contraceptives and how each of the methods works without any misconceptions has great odds of contraceptives use. This will make users more informed and confident in deciding which type or method of contraception to use. For instance, in developed nations where contraceptive knowledge is high, virtually all those who are willing to use any form of contraceptives at some time in their reproductive lives have the opportunity to use it because contraception in developing nations is viewed as a basic right (Morgan, 2014). Contrary
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to that other report establishes that the use of contraceptive in developing countries is very low
(Egede et al., 2015)
In Ghana study by Hindin, McGough, & Adanu, (2013), found that knowledge on various methods of contraceptive and its effectiveness and also knowledge about how their reproductive system work basically act as a barrier to the use of contraceptives. This low knowledge of contraceptives and how it works breeds a lot of misconceptions and the fear of health effect and the need for a woman to do a blood test to determine which method of contraceptive was appropriate to use.
It was thus, creating avenues for people to advance and progress knowledge of how various methods of contraceptives works and are used, as well as addressing the myths and misperceptions about contraceptive use would help improve contraceptive prevalence. Currently, knowledge of at least one contraceptive method among female and males in Ghana is high with 98% and 99% respectively (Amalba, Mogre, Appiah, & Mumuni, 2014).
Moreover, a study in Uganda, investigating the knowledge and attitudes of women age 15-49 towards Long Acting Reversible Contraceptives (LARC) shows that knowledge of method and the prescription center were positively associated with contraceptive use (Anguzu et al., 2014).
However, another research done in Sikkim in India, indicated when adolescent have high knowledge in contraceptive does not necessarily always lead to the use of contraceptives and that there was the need to understand the culture in a particular community before introducing any intervention to improve contraceptive use (Prachi et al., 2008).
Knowledge and awareness of contraceptive use has become a topical issue probably in view of the fact that untimed pregnancies continues to increase in adolescent and rates of sexually transmitted infections also remains to be very high even in industrialized centuries where system are in place
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to regularize and maintain widespread availability of effective contraceptives (Srikanthan & Reid,
2008). However, it could be said that having knowledge of contraceptives alone may not be in a motivating factor to improve contraceptive use among adolescent but there is the need to look at other contextual barriers which also hinders contraceptive use in order to address them holistically.
A wider approach to understanding these barriers associated with contraceptive use has the potential to inform the development of interventions aimed at increasing contraceptive use
(Stephenson, Baschieri, Clements, Hennink, & Madise, 2007).
Making knowledge and awareness of contraceptive methods and types accessible among the public and reducing myth and misconception about various types and methods of contraception and the need to use them is an integral part of any decision or effort to promote contraceptive use. In
Ghana, the adoption of strategies in social marketing such as print and electronic media carry adverts in different ways on daily basis to sensitize and create awareness about the different types of contraceptives (Hindin et al., 2013). These public advocacy programs are usually initiated by the government through the Ghana Health Service, Ministry of Health, Development partners,
Non-governmental Organizations and philanthropist to help create knowledge and awareness about reproductive health problems or issues, including contraceptive use (Mehra et al., 2012).
Studies have found the use of communication channels whether formal, informal or unofficial such as conversation, the town crier, the marketplace, churches, schools, health officers and radio and televisions are very useful in creating public awareness and increasing knowledge of health needs and health-care delivery in Ghana (Okereke, 2010).
In order to attain a wide coverage of the use of contraceptives, there is the need to ensure the availability of all the different types and methods. This could go a long way to promote the use of contraceptives. Egede et al., (2015), reported that ensuring that there all the types of contraceptives
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are available where a decision could be made about any of the methods to use with restricting to what is available is an important way of controlling population growth, sexually transmitted diseases, abortion and other complications of pregnancy. The essence of making available contraception methods in order to improve contraceptive use and family planning coverage which was accentuated by the Ghana Millennium Development Goals Acceleration Framework in one of their report which took cognizance of the issue that making available family planning commodities in health facilities was one of the major tailbacks that needed to be addressed in order to improve maternal health in Ghana (Apanga & Adam, 2015).
Moreover, unplanned pregnancy among adolescents is considered as a public health problem that has major consequences for the individual adolescent, the family, and society at large; and making contraceptive available to adolescent anytime the need arise has been found to contribute significantly in reducing the rate of unintended adolescent pregnancy and STI (Morhe, Tagbor,
Ankobea, & Danso, 2012). In view of this, making contraceptives available to all when the need arises could be a necessary intervention towards preventing adolescent pregnancy.
Another study found that availability of any methods or type of contraceptive help women in their reproductive age to use emergency contraceptive and health providers are advised to make contraceptive available persons who want to use it but have unmet need (Amalba et al., 2014). In
Ghana health care is provided by two sectors, the public sector managed by the government through the ministry of health and private sector managed by individual and it is estimated that half of the health care provided in the country is by private individuals (Adjei et al., 2015). The ability of these care providers to meet the demand of contraceptive users is very important due to the fact that limited choice of contraceptive methods reduces the chances for users to choose from a lot which method best suits their need but not what is available (Egede et al., 2015).
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Of all the social determinant known to influence contraceptive usage, religion exerts a weighty and an overriding influence on contraceptive usage. For instance, irrespective of one's level of knowledge or awareness or economic status, one's religious beliefs on contraceptive use has enormous influence on the usage of contraceptive by the person. Thus, religion plays a significant role the human ecosystem and comprises of values, norms which predominantly shapes and regulate individual behaviour, including sexual and reproductive health behaviour, hence it is important to examine its influence on contraceptive use among adolescent. Studies in northern, central, and western Nigeria, showed that differentials in contraceptive behaviour existed among women as a result of their religious background (Akintunde, Lawal, & Simeon, 2013).
Another study was done in Cameroon, Ghana, and Malawi, confirm the work done by previous researchers in the field of religion and contraceptive usage that contraception differentials among the religions vary because of the doctrinal positions of each religious body on contraceptive use
(Doctor, Phillips, & Sakeah, 2009). Contrary to the report that religion has an influence on contraceptive use, the relationship between contraceptive use and religion remains a question of considerable debate. (Agadjanian, 2013).According to Ngome & Odimegwu (2014), found religious affiliation has no influence on contraceptive use. Moreover, a study in the United States of America found that 99% of all adolescents said their religion is not against contraceptive use.
(Jones & Dreweke, 2011). Also, another study in Nigeria shows that contraceptive is generally accepted by almost all the religions, but some are also of the view that children are a divine gift from God and therefore should not be prevented from coming into the world. (OLI, 2017). Also there was a study on religious domination in southern Mozambique and it was identified that religious involvement reveals that frequent church attendance has a net positive association with modern contraceptive use regardless of denominational affiliation ( Agadjanian, 2013) Another
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study conducted in the University of Ghana on perception of students whether religion influence their contraceptive use but was found out that contraceptive has no influence on contraceptives usage among the students. Another study in the Upper East of Ghana also suggests that religion has no influence on contraceptive use (Achana et al., 2015).
It is believed that partners have the tendency of impacting on contraceptive use among reproductive-age women since husbands may hold a different view on the issue of contraception.
Research shows that in Sub-Saharan Africa, contraceptive use is strongly influenced by men’s opinions (Anguzu et al., 2014). For instance, a study found that 43% of Namibian men and 46% of Ghanaian men have the view that a woman who uses contraceptives might become immoral and some women also opposed contraception for fears of partners disapproval (Burdette, Haynes, Hill,
& Bartkowski, 2014). This was in agreement with a study in Uganda, which found that men’s opposition to contraception was associated with an increase in women not using contraceptives though they want to prevent pregnancy or space birth, where two in five women who were not practicing family planning said their partner’s disapproval was a reason for not using contraceptives (Do & Kurimoto, 2012). Moreover, Apanga & Adam, (2015), studied why women face a lot of barriers in accessing family planning services in the Talensi District of the Upper East
Region of Ghana and found that one of the major reasons for not accessing family planning services was because their partners were not in support of it. Additionally, Do & Kurimoto,( 2012), found that many men in Ghana and Zambia were concerned about other people controlling the reproductive behaviour of their wives other than them. In addition, a study found that some adolescents do not use contraceptive because their partners were young to decide which type of method to use (Anjum et al., 2014).
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Majority of the work done looking at the fear of side effect and misconception and contraceptive use has always reveal significantly that it is a critical issue hindering contraceptive uptake among sexually active persons who are either not ready to give birth, want to space childbirth, who want to prevent STIs or teenage pregnancy. According to Nalwadda, Mirembe, Byamugisha, & Faxelid,
(2010), adolescents were of the view that, contraceptives interfered with fertility, and they were frightened to use something that could jeopardise their ability to reproduce in future. Most adolescents interviewed believed that pills burned eggs in their wombs. Both male and female participants believed that pills accumulate in the body caused swellings, such as fibroids, cancer, destruction of the fallopian tubes. Some females also complain that it leads to abortion. Participants were also convinced that the intrauterine device could pierce the uterus (Chernick et al., 2015).
Condoms were believed by adolescents that it damages the uterus, to get stuck in the reproductive tract and cause death, not to fit properly, to be porous, and to have infectious lubricant. Male participants reported tension and suspicion when using condoms because they thought ‘White’ had infected condoms with HIV. Others believed that the oil on the condoms was infectious to women and feared that condoms had pores or grooves with actual perforations that allowed transmission of HIV (Boamah et al., 2014).
Another work is done in Kenya also confirmed that fear about family planning was the main barrier to use. Most of them were afraid because of the myths and misconceptions associated with it. The fear of not given birth in the future in many cases, this prevented them from using contraception
(Ochako et al., 2015).
In addition to the myths described above, a study was done on misperceptions, misinformation, and myths about modern contraceptive use in Ghana, a majority of the respondents mentioned side
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effects as a barrier why they do not patronize contraceptives. The commonest side effects reported by respondents were weight changes, bleeding, and lack of sexual desire (Hindin et al., 2013).
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CHAPTER THREE
METHODOLOGY
3.1 Introduction
This chapter describes the methodology that was used in this study. Issues that were covered in this chapter include research design, study area, study population, sample, sampling techniques, data collection and data analysis, variables of the study and ethical approval.
3.2 Study Design
The study design was a cross-sectional study design, which involves the use of the quantitative method of gathering the information. This design was appropriate for the study because data on knowledge, prevalence, and barriers to contraceptive use among in-adolescents in Adaklu district were collected at one point in time.
3.3 Study Area
Adaklu District is relatively a new district carved out of from Adaklu-Anyigbe district in 2012, which is now Agotime-Ziope district. According to the 2010 Population and Housing Census, the population of Adaklu district is 36,391 representing 1.7 % of the region’s total population. Males with 49.0 % and females represent 51.0 %. The district is completely rural with no urban settlements. It shares boundaries to the east with Ho-West, North-Tongu district to the south,
Agotime-Ziope district to the north and Akatsi-North district to the east with. The district covers a total land area of 800.8sqkm.
Adaklu district has one government assisted senior high school, a private senior technical school, and 31 basic schools. In Adaklu, 12 years and above have access to mobile phones, internet, and
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laptop or desktop. Fertility in Adaklu begins from the age of 12. The main occupation in Adaklu is farming.
3.4 Study population
The study consists of adolescents from the ages of 12-19 years in Adaklu Senior High School and five Junior High Schools in Adaklu district. Though, WHO defines adolescent as persons with age range from 10-19 years, most of the teenage pregnancy cases that were reported in Adaklu are found among this population.
3.5 Inclusion and Exclusion Criteria
3.5.1 Inclusion Criteria
All students who were around both in Adaklu Senior High School and some selected Junior High
School and also who aged between 12 – 19 years. Only those eligible and were willing to participate in the study were selected.
3.5.2 Exclusion Criteria
Students who had been sacked home for school fees and students who were below and above the ages 12- 19 respectively were let off from the study. Also, students who for one reason or the other did not want to be part of the study were not included.
3.6 Variables of the Study
3.6.1 Dependent Variables
The dependent variable considered for the study was contraceptive use among in-school adolescent.
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3.6.2 Independent Variables
The independent variable for the research are sex, age, educational level, religion, methods of contraceptive use, source of information, knowledge on contraceptives, living arrangement, source of contraceptives, access to contraceptives, negotiate contraceptive with partner, age of first sex, reasons for using contraceptives, cost of contraceptives, attitude of contraceptive service providers, side effect, opposition from parent/partner, and infrequent sex.
3.7 Sampling
3.7.1 Sample Size Estimation
1. Estimated population based on adolescent’s contraceptive prevalence rate of 21% based on the findings of a study of contraceptive among secondary school adolescents (Hagan & Buxton,
2012).
2. 95% confidence level
3. 5% Margin of error.
Using Cochran equation of sample size for the sample size determination
푧2푝 (1−푝) 푛 = 푑2
Where: n= minimum required a sample size z= confidence interval at 95% p= estimated the proportion of adolescent using a contraceptive.
(1.96)2 × 0.21 × 1− 0.21
(0.05) 2
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0.637/0.0025 n= 254.9≈ 255
The sample size calculation was 255 but 10% was added to round the sample size to 280 this was to take of non-respondents, damage questionnaires, and withdrawer from the study
3.7.2 Sampling Procedure
The sampling was done using 5 junior high schools out of the 31 junior high school and the only senior high school within Adaklu district. The population of each school was divided by the total population of all the schools and multiplied by the total sample size to ascertain the total number of students to be interviewed in each school. systematic random sampling was done using the class register as the sampling frame. The total number of students in each class was divided by the sample to be selected to get the sampling interval for each of the schools. Excel formula =rand between (1, interval) term generated to get the starting point. The last thing was done by selecting the samples from the register with the starting point number and an interval.
Name of Population Population Interval Schools Interviewed Goefoe D/A 102 31 3 JHS Kodzobi D/A 90 28 3 Basic Anfoe D/A JHS 82 26 3 Sofa D/A Basic 95 30 3 Hlihave D/A 77 24 3 Basic Adaklu Senior 450 141 3 High School Total 890 280
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3.8 Pretest
The questionnaires were pretested with 30 students in Agotime Senior High Senior and Agyina junior high school in Agotime-Ziope to help solve unforeseen problems that may arise on the field in terms of question ambiguity, missed page numbers, and missed coding, including questions not answering the objectives. The questionnaires were fine-tuned based on the responses from the pilot prior to the main data collection.
3.9 Data Collection Techniques
Quantitative data were collected with a structured questionnaire which was self-administered by students. The questions were worded in English and coded for easy entering of data into an analysis software, but technical words and phrases were explained to students. Two male and a female
Senior High graduate will be trained for two days to collect the data. Techniques of data collection were addressed, creating bonds, ensuring of privacy and confidentiality of respondents, the question was designed devoid of ambiguity, the meaning of the items and the correct ticking of responses was provided. Data collection was thoroughly coordinated by the principal investigator.
Questions were designed to show skip patterns in the questionnaire when necessary. Questions looked at students’ demographic background, contraceptive knowledge, prevalence and barriers.
3.10 Data Processing and Analysis
After the data collection process was completed, the data was checked for correctness and consistency. The completed questionnaire was checked and rechecked by all the researchers to make sure that all mistakes were corrected before data entering and analysis.
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Data entering was done independently by the three research assistants and compared by the principal investigator to make sure that the right information from the field was captured correctly.
The coded data were entered into a statistical package for social science (SPSS) version 23. Data entering was done using the identification number on the questionnaire to avoid entering a questionnaire twice into the software. Descriptive statistics were generated to describe the frequencies and percentages of the respondents. Mean and the standard deviation was calculated for continuous variables. Pearson's chi-square analysis was done to determine the associations between the independents and dependent variables. The dependable variable was a dichotomous variable, where yes took a value of 0 and no with a value of 1. Binary logistic regression analysis was done to identify the potential factors influencing current contraceptive use. In all analyses,
95% confidence interval and p-values less than 0.05 (p<0.05) were used to determine statistical significance. The result was exported to excel 2016 and the final result presented using tables, graph, and chart.
3.11 Quality Control
After data collection, the hard copy was saved in a brown envelope name in a way that did not suggest that it is a filled questionnaire, sealed and locked in a drawer. The soft copy was deleted from the computer used for the analysis but emailed to the researcher's email to allow for easy reference for future use. The data was only limited to the principal researcher and the research assistants.
To help ensure smooth data collection and analysis, research assistants were trained. This training was necessary to ensure that the research assistants understood the topic, objectives, research questions and the format of the questionnaire and its contents. The research assistants were also
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trained on how to go about the consenting procedure, however, the principal investigator was around to supervise the research assistant on the field to make sure that things are done appropriately.
3.12 Ethical Issues
Ethical clearance and approval were sought from the Ghana Health Service Ethical Review committee. The approval letter was duly obtained (Ethics Approval ID NO: GHS-ERC:026/12/17) before the study was conducted. Letters from the school of Public health introducing the principal investigator and the purpose of the study was sent to the Adaklu District Education Office, as well as the heads Senior High Schools and the Junior-Senior High. Also, written consent was sought from the parents or guardians of students below the age of 18. The participants were given clear explanations of the objectives and details of the study as well as its benefits. Those who agreed to be a part of the study were asked to give acknowledgement by signing the consent form. They were also made aware that, notwithstanding their consent given, they were free to pull out from the study at any point in time they felt they did not want to continue. To ensure confidentiality, student’s identities were anonymous and undisclosed at every point of the study. Data collected were password protected, stored on the computer and backed up on the external hard drive. Hard copies were locked up in cabinets with limited access to only the principal investigator and the supervisor of the study.
This research was self–sponsored. Respondent was given an exercise book as a form of compensation for participation in the research. This was given after the interview to ensure that, the responses from the participants were not biased on account of the hope of remuneration. The principal investigator has no conflict of interest with regards to the study.
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CHAPTER FOUR
RESULT
4.1 Introduction
This chapter presents the result of the study among adolescent in Adaklu district on their knowledge and barriers to contraceptive. There are four sections in this chapter. Section one looks at the socio-demographic characteristics of the respondents. Section two present knowledge of contraceptives of respondents. Section three present contractive use among respondents and the last section present barriers to contraceptive use.
4.2 Socio-Demographic Characteristics of Respondent
A total of 280 questionnaires were administered but 270 were appropriately completed representing 96% response rate. The socio-demographic characteristics provide a clear understanding of the background of respondents. Data were collected on sex, age, educational level, religion, who respondent lived with, who they discussed sex issues with and how often they discussed sex issues. Information regarding the background characteristics of the study participants is shown in table 4.1.
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Table 0-1 Socio-Demographic Characteristics of Respondents
Variable Frequency (N=270) Percent (%) Sex Male 142 52.6 Female 128 47.4 Age (Mean, SD±) (16.09,1.763) <14 51 19.0 15-19 219 82.0 Educational level JHS 1 65 24.1 JHS 2 47 17.4 JHS 3 50 18.5 SHS 1 84 31.1 SHS 2 20 7.4 SHS 3 4 1.5 Religion Christian 241 89.3 Muslim 18 6.7 Traditionalist 11 4.0 Leaving with Both parent 126 46.7 Mother 86 31.9 Father 27 10 Other relatives 10 3.7 Guardian 16 5.9 Partner 5 1.8
The respondents were made up of males 142 (52.6%) and females 128 (47.4%). The mean age of the respondent was 16.09 (SD±1.763), with a minimum age of 12 years and a maximum of 19 years. Sixty per cent of respondents were in Junior High School and 40.0% in Senior High School.
Majority of the respondents were Christians 89.3%. Also, the higher proportion of respondents
(46.7%) lived with both parents, whiles 31.9% lived with mother (Table 4.1).
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4.3 Contraceptive Knowledge of Respondents
Knowledge of contraceptives was found to be high among respondents. Of the 270 respondents,
88.0% know something about contraceptives. Though a majority of respondents knew about contraceptives, only 18% were able to mention more than one methods of contraceptives. With regard to the source of contraceptive information, television (41.5%) was the major source of information on contraceptives reported. This was followed by health workers (38.9%) and the least source of information was from siblings (12.2%). In terms of which contraceptive methods respondents knew, a majority (74.7%) mentioned condom while the least method reported was jell/foam (6.3%). A majority (80.4%) of the respondents got their contraceptive method from the hospital/health centers (Table 4.2).
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Table 0-2 Knowledge of Respondents on Contraceptives Variable Frequency N=270 Percent (%) Knowledge of respondents Yes 237 88.0 No 33 12.0 Knowledge level High knowledge 49 18.0 Low knowledge 221 82.0 Method Known Condom 177 74.7 Injectable 65 27.4 Pills 64 27.0 IUD 27 11.4 Natural 26 11.0 Female sterilization 24 10.1 Male sterilization 19 8.0 Norplant 17 7.2 Jell/Foam 15 6.3 Source of information Television 112 41.5 Health worker 105 38.9 Teacher 101 37.4 Peer 95 35.2 Radio 91 33.7 Parent 45 16.7 Newspaper 38 14.1 Magazine 35 13.0 Siblings 33 12.2
Source to get contraceptive Hospital/health center 148 80.4 Pharmacy/chemical shop 88 47.8 Friends 30 16.3 Parent 19 10.3 Youth centers 12 6.5 Maternity home 9 4.9
4.4 Knowledge of Contraceptives and Socio-Demographic Characteristics
The study found a statistically significant association between age and knowledge of contraceptive(p<0.006), but the other variables were not statistically significant (Table 4.3).
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Table 0-3 Knowledge of contraceptives and Socio-Demographic Characteristics
Variables Frequency Have knowledge Have no P-Value (N=270) of contraceptives knowledge of (%) N=237 contraceptives (%) N=33 Sex Male 142 128(90.1) 14(9.9) 0.212 Female 128 109(85.2) 19(14.8) Age <14 51 76.5(76.5) 12(23.5) 0.006* 15-19 219 198(90.4) 21(9.6) Educational level JHS 1 65 55(84.6) 10(15.4) 0.262 JHS 2 47 42(89.4) 5(10.6) JHS 3 50 43(86.0) 7(14.0) SHS 1 84 78(92.9) 6(7.1) SHS 2 20 15(75.0) 5(25.0) SHS 3 4 4(100) 0(0.0) Religion Christian 241 211(87.6) 30(12.4) 0.936 Muslim 18 16(88.9) 2(11.1) Traditionalist 11 10(90.9) 1(9.1) Leaving with Both parent 126 104(82.5) 22(17.5) 0.213 Mother 86 78(90.7) 8(9.3) Father 27 25(92.6) 2(7.4) Other relatives 16 15(93.7) 1(6.3) Guardian 10 10(100) 0(0.0) Partner 5 5(100) 0(0.0) * Chi-Square test is significant at P< 0.05.
4.5 Current contraceptive use among in-school adolescent
Out of 270 respondents, only 18% reported that they were using a modern contraceptive at the time of the study, whiles majority (82%) reported that they do not use any modern contraceptives.
The overall prevalence of modern contraceptive use among in-school adolescent in Adaklu district is 18% as shown in figure 4.1.
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ever used contraceptive
49, 18%
Yes
No
221, 82%
Figure 0-1Ever Used Contraceptives
However contraceptive prevalence was high at 20% among respondent between the ages of 15-19 compared to the ages 14 and below (10%) (Table 4.5).
Over half of the respondents (55.1%) reported that they use contraceptives anytime they had sex.
Various reasons were given for using contraceptives and the most prominent among them was to prevent pregnancy and STDs. A majority (42.9%) of the respondents said they discussed the methods of contraceptives with their partners for the first time they had sex. Also, 69.4% of the respondents reported that they use contraceptives during their first sex. With regards to the methods used majority (83.7%) used a condom. Respondents were asked the reason why they used a particular method, 36.7% reported that they have better knowledge about the method they used
(Table 4.4).
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Table 0-4 Prevalence of Contraceptive Use Variables Frequency (N=49) Percent (%)
Contraceptives used anytime had sex Yes 27 55.1 No 22 44.9 Reasons for used To prevent pregnancy 11 22.4 To prevent STDs 14 28.6 To prevent pregnancy and 24 49.0 STDs
Discuss contraceptive first time of sex Yes 21 42.9 No 16 32.7 Do not remember 12 24.5 Contraceptive used the first time of sex Yes 34 69.4 No 12 24.5 Do not remember 3 6.1 Method used Condom 41 83.7 Pills 5 10.2 Safe period/calendar 3 6.1 Reasons for used Easy to use 9 18.4 Easy to get it 6 12.2 Cheap to buy 5 10.2 Got it for free 11 22.5 Have better knowledge 18 36.7
4.6 Contraceptive use and demographic characteristics
A chi-square test of association was done to assess an association between contraceptive use and demographic characteristics of respondents. Sex (p>0.233) and age (P>0.086) was not significantly associated with contraceptive use. However, there was a significant association between educational level (p<0.050), religion (p< 0.03) and who respondents leave with (p<0.013)
(Table 4.5).
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Table 0-5 Current Contraceptive Use and Socio-Demographic Characteristics Variables Frequency Used Do not used P-Value (N = 270) contraceptives contraceptives N (%) N (%) Sex Male 142 22(15.5) 120(84.5) 0.233 Female 128 27(21.1) 101(78.9) Age <14 51 5(9.8) 46(90.2) 0.086 15-19 219 44(20.1) 175(79.9) Educational level JHS 1 65 11(16.9) 54(83.1) 0.050* JHS 2 47 11(23.4) 36(76.6) JHS 3 50 6(12.0) 44(88.0) SHS 1 84 14(16.7) 70(83.3) SHS 2 20 4(20.0) 16(80.0) SHS 3 4 3(75.0) 1(25.0)
Religion Christian 241 38(15.8) 203(84.2) 0.003* Muslim 18 5(27.8) 13(72.2) Traditionalist 11 6(54.5) 5(45.5) Leaving with Both parent 126 18(14.3) 108(85.7) 0.013* Mother 86 16(18.6) 70(81.4) Father 27 6(22.2) 21(77.8) Other relatives 16 2(20.0) 8(80.0) Guardian 10 3(18.8) 13(81.3) Partner 5 4(80.0) 1(20.0) NB Chi-Square test is significant at P< 0.05. *Shows significant variables
A logistics regression analysis was performed to assess the impact of the demographic variables that were significantly associated with contraceptives use. Traditional religion was the only variable that was significantly associated with contraceptive use (OR=0.191, CI=0.040-
0.913)(Table4.6).
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Table 0-6 Regression Analysis and Contraceptive Use
Variables Odds Ratio (95% confidence P-value interval) Religion Christianity Ref Ref Muslim 0.441 (0.131-1.485) 0.186 Traditionalist 0.191 (0.040-0.913) 0.038* Educational level JHS 1 Ref Ref JHS 2 0.586 (0.209-1.640) 0.309 JHS 3 2.778 (0.859-8.982) 0.088 SHS 1 1.766 (0.683-4.565) 0.241 SHS 2 1.343 (0.339-5.314) 0.674 SHS 3 0.244 (0.004-13.742) 0.493
Leaving with Both parent Ref Ref Mother 0.789 (0.359-1.732) 0.555 Father 0.727 (0.239-2.206) 0.573 Other relatives 0.876 (0.135-5.697) 0.890 Guardian 0.855 (0.206-3.547) 0.829 Partner 0.061 (0.003-1.057) 0.060
NB; Ref represent the reference category *p<0.05 0 = Contraceptive use and 1= No contraceptive use
4.8 Barriers to Non-Use of Contraceptives Contraceptive
Of the 221 respondents who reported not to have used contraceptive method majority (47.5%) reported fear of side effect as their reason for not using contraceptives, followed by lack of knowledge on contraceptive and it proper use (36.7%) Moreover, religion (33,0%) and the fear of being seen by parent (32.1%) were also reported as reason for not using contraceptives
(Figure 4.2).
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50.0 47.5 45.0
40.0 36.7 35.0 33.0 32.1 30.0 25.8 25.0
20.0 14.0 15.0 13.6 11.3 10.9 9.5 10.4 10.4 10.0 4.5 4.1 5.0 3.6
0.0
yes
Figure 0-2 Barriers to Contraceptive Use
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CHAPTER FIVE
DISCUSSION OF FINDINGS
5.1 Introduction
This chapter looks at the discussion of the findings of the study in relation to other studies as the basis for finding similarities or disparities. The discussion is done in a systematic manner along the line of how the result was presented.
5.2 Knowledge of Contraceptive Use
The findings of the study reveal that knowledge of contraceptive among in-school adolescent is
88%. This is to suggest that the majority of in-school adolescent know about contraceptives.
Knowledge of contraceptives could be partly a result of current behaviour change communication and social marketing activities in the area of family planning in the form of visual and audio advertisement. This is in line with studies that also found that contraceptive knowledge is high among adolescents (Ochako et al., 2015; Hagan & Buxton, 2012). This was not the case when it came to the number of contraceptive method adolescent knew, only 18% knew more than one methods of contraceptives. This means that adolescents knew about contraceptives but their level of knowledge is limited and this could affect the use of contraceptives because it will limit their choice of contraceptives use.
The common source of information on contraceptive is from television and health workers, this was followed by radio, peers, and teachers. This corroborates with a study done in Nigeria which found that health workers were the source of information for adolescents on contraceptive use,
(Oyedokun, 2007). On the contrary, (Hoque, Ntsipe, & Mokgatle-Nthabu, 2013) found that the major source of information on contraceptives uses among adolescents in Botswana was from the
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school and health facilities followed by television and radio. Also Somba, et al.,(2014) found that the main source of contraceptives is peers, teachers, and radio respectively. Moreover, a study in
Ghana also had a contrary view which suggests that the main source of information on contraceptive use among adolescents was television and radio, (Boamah et al., 2014). These disparities in findings could be as a result of the availability of electronic and print media accessibility and health institutional policy in Adaklu district. Nevertheless, the result shows an important trend that when behavioural communication strategies are intensified in addition to health education and a home visit by nurses more adolescent will have information on contraceptives use.
In addition, the findings showed that knowledge of the source of contraceptive use among in- school adolescent in Adaklu district was health facility and pharmaceutical shops. The preference of health facility as the source of knowledge of contraceptives among in-school adolescents could be as a result of access to free contraceptives from health facilities and pharmaceutical shops perhaps because of proximity. This is in an agreement with a study in Botswana (Hoque et al.,
2013) which found that the commonest knowledge of contraceptives is the health facility. This is also consistent with a study by Somba et al., (2014) where it was found that pharmaceutical shops are the source of knowledge of contraceptives.
This finding of the study further demonstrates that majority of in-school adolescent knowledge of commonest methods of contraceptive are condom, pills, and injectables. However, a smaller percentage was familiar with IUD, jell, male sterilization, female sterilization, and Norplant. This is also not suppressing because these methods are the commonest methods of contraception for adolescent access. The finding is inconsistent with a study by Bankole, and Onasote ( 2017) which found that male and female sterilization were the least methods of contraceptive known by an
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adolescent. These findings are also in agreement with a study by Oye-Adeniran et al., (2006) which found that they were the least methods of contraceptive known.
It was expected that educational attainment will be associated with knowledge of modern contraceptive use. However, this study found that educational level has no association with knowledge of modern contraceptive. This finding reflects the lack of reproductive component in the school curriculum, especially in the basic school level. Moreover, other socio-demographic characteristics such as religion, who adolescent leave with were also found not to be associated with knowledge of modern contraceptive use similar to Mohammed, et al, (2014) findings.
However, there was a statistically significant association between age and knowledge of contraceptive.
5.3 Prevalence of Contraceptive Use
The overall prevalence of modern contraceptive use among in-school adolescents in Adaklu district was found to be 18%, which is currently below Ghana Health Service national family planning target of 23.3% (Apanga & Adam, 2015). However, this finding relates to similar percentages in the Ghana Demographic Health Survey that the prevalence of contraceptive use among adolescent was 19%,(GDHS, 2014a). A study by Yidana et al., (2015) on social-culture determinants of contraceptives use among adolescents in Northern Ghana found contraceptive use to be 18.3%. This is also in tandem with a study by (Hagan & Buxton, 2012) which found that contraceptive use among adolescents in selected schools in the Central Region is 17.8%. In spite of the fact that knowledge of modern contraceptive was found to be 82%, current use was low.
This reveals that knowledge of contraceptive may not result in contraceptive use. This is supported
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by findings study in India (Prachi, Das, Ankur, Shipra, & Binita, 2007), and Nigeria (Egede et al.,
2015), that knowledge of contraceptives does not translate to use.
Even though contraceptive use was low, there was an unequal use of condoms when compared to other contraceptive methods. Likely reason for this could include the fact that adolescents are more knowledgeable and easy access to condoms. Condoms are available almost everywhere, ranging from the pharmaceutical shops or chemical shops, supermarket to restaurants. The adolescents do not have to go to the health facility to get condoms, which is not so for other methods. Sometimes going to the health facility for contraceptives methods could be a difficult task for adolescents considering the hostile behaviour shown towards them. Adolescents are most likely to be derided, reprimanded or sometimes turn away by service providers at the health facilities. Another reason for condom use might be that condoms are cheaper, as compared to the other contraceptive methods. This finding was in agreement with a study by Hagan & Buxton, (2012) and Kagashe &
Honest, (2013).
Moreover, another reason for the disparity in condom use and other methods was better knowledge using condoms compare to other methods.
In addition, most of the in-school adolescent use condom compared to other methods because they want to prevent pregnancy and sexually transmitted diseases. These findings were in agreement with similar findings by (Mahama & Owusu-agyei, 2014).
The findings also show that late adolescents were more likely to use contraceptive compared to early adolescents. This is because the formal is more matured and exposed to information, have easy access to any method of contraceptives. Whereas the later does not have it easy using contraceptives because it is assumed that at their age they should not have anything to do with sex that will trigger them to use contraceptives for any protection or whatsoever. Besides, adolescents
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between the ages of 15-19 are likely to be working, married and possibly have attained a more educational level, and more likely to be sexually active than their younger counterparts. This is consistent with (Nyarko, 2015) where there was a similar finding. However, age was not significantly associated with contraceptive use. This contradicts a study done in Burkina Faso,
Ethiopia, and the Gambia, which found that the age of adolescents has an influence on contraceptive use (Hounton et al., 2015).
Moreover, traditional religion was also significantly associated with contraceptive use among in- school adolescents. In a multivariate analysis, adolescents who were traditionalist indicated that they will consider their religious before making a decision on using a contraceptive. This is supported by findings of a study in Uganda, that religious influence was a significant predictor of contraceptive use (Orach et al., 2015). Also, Wusu, (2015), reported that religious influence was significantly associated with contraceptive use.
Educational level for respondent was significantly associated with contraceptive use. However, after a multivariate analysis, there was no significant relationship between educational level and contraceptive use. This finding contradicts studies by Mekonnen & Worku, (2011), Nyarko,
(2015), Mohammed et al., (2014) and Achana et al., (2015) who reported an association between educational level and contraceptive use, while Nketiah-Amponsah et al., (2012) also found that level of education is a predictor of contraceptive use among adolescents.
Furthermore, there was no association between the sex of respondents, who they were leaving with and contraceptive use. However, Mehra et al., (2012) in their study on determinants of non- contraceptive use among Uganda University students found a significant association between sex, who adolescent leave with and contraceptive use.
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5.4 Barriers to Contraceptive Use
The major factors mentioned as the barriers to contraceptives use our fear of future side effect, lack of knowledge on usage, religion, afraid of being seen by parent and friends and the cost of buying contraceptives. This is in agreement with a study by Williamson et al., (2009) adolescent’s faces a number of barriers to obtaining contraception and in using them correctly and consistently.
They also indicate that there are many barriers that prevent the use of contraceptives among adolescents. These barriers include; poor knowledge of contraceptive, fears of future side effect, influences of partners and family member.
Of all the social determinant known to influence contraceptive usage, religion is one of the determinants that exerts a weighty and an overriding influence on contraceptive usage. For instance, irrespective of one’s level of knowledge, one’s religious beliefs on contraceptive use has enormous influence on the usage of contraceptive by adolescents. Studies in northern, central, and western Nigeria, showed that differentials in contraceptive behaviour existed among adolescent as a result of their religious background (Akintunde et al., 2013). Contrary to the report that religion is a barrier to contraceptive use Ngome & Odimegwu (2014), reported that religious affiliation has no influence on contraceptive use.
Another finding was that adolescents were not using contraceptives because of their knowledge about the methods of contraceptive use. This is not surprising because even though adolescents knew about contraception their knowledge on more than two methods was very low and this is in agreement with (Egede et al., 2015) knowledge on contraceptive methods has an influence on contraceptive use.
Furthermore, another barrier to contraceptive use among in-school adolescents in Adaklu district was fear of side effect. This finding is also consistent with Nalwadda et al., (2010), that,
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adolescents believed that contraceptives interfered with fertility, and they were afraid to use something that could harm their ability to reproduce. Similarly, a study on barriers to and enablers of contraceptive use among adolescents found side effect as a hindrance to contraceptive use.
Another major barrier to contraceptive use among in-school adolescent in Adaklu district was the cost of buying contraception. This was expected because this was adolescent who was still under the care of their parent and possibly their sexual partners were also not working. This corroborates with studies by Ochako et al., (2015) which also found that cost of contraception was a barrier to contraceptive use among adolescent. This is also in line with (Yidana et al., 2015) who also found the cost of buying contraceptive as barriers to contraceptive use.
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CHAPTER SIX
CONCLUSION AND RECOMMENDATION
6.1 Conclusion
The objectives of this study were to assess the knowledge of in-school adolescents on contraceptive use, to determine the prevalence of contraceptive use and to identify barriers to contraceptive use.
In connection with objective one, knowledge on contraceptive use was widely known (88%), but the level of contraceptive knowledge was low (18%). A major source of contraceptive information was television and health workers. The condom was the major method of contraceptive known.
Also, the majority of respondents mentioned hospital and pharmaceutical shops as the source of where to get contraceptives. Knowledge of contraceptive use was not significantly associated with contraceptive use.
Regarding objective two, the prevalence of contraceptive use. Only 18% of respondents had used any methods of contraception. Adolescents 15-19 years had a higher percentage using contraceptives compare to their counterpart 14 years and less. Majority of respondent used a condom and their reasons were to prevent both pregnancy and sexually transmitted diseases.
Another reason was also the fact that they had better knowledge of a condom than the other methods. Contraceptive use was significantly associated with educational level, religion, and who adolescents leave with. But after a multivariate analysis, only traditional religion was found to had influence on contraceptive use among in-school adolescents in Adaklu district.
The major barriers to contraceptive use were fear of side effect, religious beliefs, fear of being seen by a parent or someone who knows them and cost of buying contraception and lack of knowledge on the proper use of contraceptives.
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6.2 Recommendation
Based on the findings of the study, the following recommendations are made for consideration by policymakers and healthcare practitioners.
1. Shed coordinators at the Adaklu district education service should organize programmes to promote safe sex and sex education which should be in form of talk shows, seminars and platform for discussions with adolescents and youth by health educators, health professionals and teachers.
2. The teachers and parents should do well to give relevant sexuality information or education to adolescents before their engaging in sexual activities.
3. The District Assembly should provide youth friendly centres in the towns and villages which should be staffed with youth and health officers.
4. The ministries of Health and Gender Social Protection should put in policies emphasizing free access to contraceptive health services for adolescents.
5. Adolescents should joint youth clubs whose mandate are to help adolescents practice obstinance and save sex.
6.3 Limitation
The limitation of the study was that the study was conducted in 5 out of 31 Junior High Schools and a Senior Secondary School and this limit generalization of the findings to the wider district.
Also, the data was collected during the time when students from Junior High School were writing their Basic Education Certificate Examination and this in a way would have compromised the data.
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APPENDICES Appendix A
School of Public Health College of Health Science, University of Ghana Parental Informed Consent. Project Title: Knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. Institutional Affiliation Department of Social and Behavioral Science, School of Public Health, College of Health Sciences, University of Ghana, Legon Introduction I am Richmond Agbanyo, a Maters of Applied Health in Social Science student of the University of Ghana, School of Public Health. I am conducting a research on the topic knowledge and barriers to contraceptive use among in-school adolescent Adaklu district.
Purpose of the study The study aims to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district. Procedure We are conducting an interview on knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. Your child has been selected to be part of those to be interviewed and we will be grateful on his/her opinion on the subject. There is no right or wrong answers. Your child’s assistance in providing responses to the questions will help better understand the knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. All that he/she says will be kept confidential and nothing he/she says will be traced back to him/her. The interview will last for 20 minutes. Your child has the right to opt out of the interview at any point in time he/she does not feel comfortable without any consequences to him/her. Risks and Benefits It is very unlikely your child will not suffer any harm by participating in this study. If he/she has any emotional pain from answering any of the questions, we will refer him/her to a psychologist for counseling. Your child will not benefit directly from this study, but the answers he/she provides will be used to inform policy for the improvement in adolescent health services.
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Anonymity and Confidentiality Whatever your child says would be treated as strictly private and confidential and will be used only for the purpose of the research. His/her name would not be used in any publication and no one will be able to trace back to your child whatever he/she said. All information collected will be stored in locked cabinets and will be destroyed after 5 years. Compensation There would be provision of one exercise book each as compensation for participation in the study and this will be done after the interview with participant. Dissemination of Results
The final report of the study would be disseminated to the schools the data was collected and school of public health.
This research has been reviewed and approved by the Ghana Health Service Ethics Review Board (GHSERC). For further questions concerning this research you may contact
Ms. Hannah Frimpong, GHS ERC Administrator on +233 507041223 and Dr. Collins Ahorlu, Noguchi, UG on +233 208195705
Volunteer Agreement Form
The above document describing the benefits, risks and procedures for the research title knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district has been read and explained to me. I have been given an opportunity to have any questions about the research answered to my satisfaction. I agree that my child should participate as a volunteer.
Signature/ Thumb print of parent/ guardian……………. Date……………………………………………………. If volunteers cannot read the form themselves, a witness must sign here I was present while the benefits, risks and procedures were read to the child’s parent or guardian. All questions were answered and the child’s parent has agreed that his or her child should take part in the research. Signature/ Thumb print of witness……………………. Date……………………………………………………. I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above individual. Signature of Researcher……………………………….. Name of Researcher……………………………………. Date…………………………………………………….
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Informed Consent for Students 18+ Project Title Knowledge and barriers to contraceptive use among in-school adolescent Adaklu district. Institutional Affiliation Department of Social and Behavioral Science, School of Public Health, College of Health Sciences, University of Ghana, Legon Introduction I am Richmond Agbanyo, a Maters of Applied Health in Social Science student of the University of Ghana, School of Public Health. I am conducting a research on the topic knowledge and barriers to contraceptive use among in-school adolescent Adaklu district.
Purpose of the study The study aims to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district. Procedure We are conducting an interview on knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. You have been selected to be interviewed and we will be grateful on your opinion on the subject. There is no right or wrong answers. Your assistance in providing responses to the questions will help better understand the knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. All your answers will be kept confidential and nothing you say will be traced back to you. The interview will last for 20 minutes. You have the right to opt out of the interview at any point in time you feel uncomfortable without any consequences. Risks and Benefits It is very unlikely you will not suffer any harm by participating in this study. If you have any emotional pain from answering any of the questions, we will refer you to a psychologist for counseling. You will not benefit directly from this study, but the answers you provides will be used to inform policy for the improvement in adolescent health services. Anonymity and Confidentiality Whatever answer you give will be treated strictly private and confidential and will be used only for the purpose of the research. Your name will not be used in any publication and no one will be able to trace back to you whatever you said. All information collected will be stored in locked cabinets and be destroyed after 5 years. Compensation There will be provision of one exercise book each as compensation for participation in the study and this will be done after interviewing participant.
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Dissemination of Results The final report of the study would be disseminated to the schools the data was collected and school of public health. This research has been reviewed and approved by the Ghana Health Service Ethics Review Board (GHSERC). For further questions concerning this research you may contact Ms. Hannah Frimpong, GHS ERC Administrator on +233507041223 and Dr. Collins Ahorlu, Noguchi, UG on +233208195705 Volunteer Agreement Form
The above document describing the benefits, risks and procedures for the research title knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district has been read and explained to me. I have been given an opportunity to have any questions about the research answered to my satisfaction. I agree to participate as a volunteer. Signature/ Thumb print of volunteer ………………………………………………. Date…………………………………………………….. I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in this research have been explained to the above individual. Signature of Researcher……………………………….. Name of Researcher…………………………………… Date……………………………………………………
Child Assent Form
Project Title: Knowledge and barriers to contraceptive use among in-school adolescent Adaklu district. Institutional Affiliation Department of Social and Behavioural Science, School of Public Health, College of Health Sciences, University of Ghana, Legon Introduction I am Richmond Agbanyo, a Maters of Applied Health in Social Science student of the University of Ghana, School of Public Health. I am conducting a research on the topic knowledge and barriers to contraceptive use among in-school adolescent Adaklu district.
Purpose of the study The study aims to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district.
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Procedure We are conducting an interview on knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. Your parent knows about this study and gave permission for you to be involved. If you agree, I will ask you to answer some questions. There is no right or wrong answers. No one will be mad at you if you decide not to do this study. Even if you start the study, you can stop later if you want. Your assistance in providing responses to the questions will help us better understand the knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district. If you decide to be in the study I will not tell anyone else how you respond or act as part of the study. Even if your parents or teachers ask, I will not tell them about what you say or do in the study. You may ask questions about the study at any time. The interview will last for 20 minutes. Risks and Benefits It is very unlikely you will not suffer any harm by participating in this study. If you have any emotional pain from answering any of the questions, we will refer you to a psychologist for counseling. You will not benefit directly from this study, but the answers you provide will be used to inform policy for the improvement in adolescent health services. Anonymity and Confidentiality Whatever answer you give will be treated strictly private and confidential and would be used only for the purpose of the research. Your name will not be used in any publication and no one would be able to trace back to you whatever you said. All information collected will be stored in locked cabinets and would be destroyed after 5 years. Compensation There will be provision of one exercise book each as compensation for participation in the study and this will be done after interviewing participant. Dissemination of Results The final report of the study would be disseminated to the schools the data was collected and school of public health. This research has been reviewed and approved by the Ghana Health Service Ethics Review Board (GHSERC). For further questions concerning this research you may contact Ms. Hannah Frimpong, GHS ERC Administrator on +233 507041223 and Dr. Collins Ahorlu, Noguchi, UG on +233 208195705 Voluntary Agreement By making a mark or thumb printing below, it means that you understand and know the issues concerning this research study. If you do not want to participate in this study, please do not sign this assent form. You and your parents will be given a copy of this form after you have signed it. Child’s Name: ………………………………… Child’s Mark/Thumbprint………………………..
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Date: ……………………………………………………
This assent form which describes the benefits, risks and procedures for the research titled knowledge and barriers to contraceptive use among in-school adolescent in Adaklu district has been read and or explained to me. I have been given an opportunity to have any questions about the research answered to my satisfaction. I agree to participate. Researcher’s Name: …………………………… Researcher’s Signature: ……………………… Date: ……………………………………………………
Appendix B: Assessment tools or Questionnaire
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School of Public Health College of Health Sciences, University of Ghana
PARTICIPANT INFORMATION SHEET
Title: Knowledge and barriers to contraceptive use among in-school adolescent in Adaklu Chief Investigators: Mr Richmond Agbanyo.
You are invited to take part in this research study. Before you decide to, please take time to read the following information carefully and decide whether or not you wish to take part. What is the purpose of this study?
The study aims to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district.
What does the study entail? This is a survey that will require you to answer a number of questions. We will begin by asking you information about yourself. All information will remain anonymous and confidential, but we will use it in order to understand who has taken part in our study. You will also be asked some questions your knowledge and barriers to contraceptive use.
Do I have to take part? Your participation is entirely voluntary. Once you have read this information sheet, you will be asked to give consent in order to continue. You are free to withdraw at any time, without giving a reason. Whether or not you provide your consent for participation will have no effect on your current or future relationship with the principal investigator.
Who can I contact if I have any questions or concerns? If you have any questions or concerns regarding this project, please do not hesitate to contact the Ghana Health Service Ethical Review Committee Administrator on +233 507041223.
CONSENT FORM Please confirm the following:
I have had explanation and I understand the aim of the study I am about to begin.
I understand that my participation is voluntary and that I am free to withdraw at any time, without giving any reason.
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I know that if I have any queries regarding this study I can contact Ghana Health Service Ethical Review Committee Administrator on +233 507041223.
I agree to take part in this study.
Date……………………………………………………
Interviewer……………………………………………..
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QUESTIONNAIRE
Please mark (√) corresponding to response. Serial No……………
I. SOCIO-DEMOGRAPHIC INFORMATION
SN INFORMATION RESPONSE CODING SKIP TO 1 Sex of respondents Male 1
Female 2 2 What is your age at your last birth day………......
3 What form are you? JHS 1 1 JHS 2 2 JHS 3 3 SHS 1 4 SHS 2 5 SHS 3 6
4 What is your religion? Christian 1 Muslim 2 Traditionalist 3 Other 5 Who do you stay with? Both parents 1 One parents 2 Other relatives 3 Guardian 4 Partner 5 Others 6 Who are you able to discuss Sibling 1 sex issues with? Peers 2 Teachers 3 Parents 4 If others specify 7 How often are you able to Once a week 1 discuss issues concerning sex? Once a month 2 Quarterly 3 Yearly 4 Never 5
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II. KNOWLEDGE OF CONTRACEPTIVES
8 Do you know about modern Yes 1 contraceptives? No 2 9 Which of the following do you Pill 1 know to be contraceptive Injectable 2 methods? Condom 3 More than one answer is Jell/foam 4 possible IUD 5 Norplant 6 Female sterilization 7 Male sterilization 8 Natural methods 9 If others specify
10 From whom or where, have Radio 1 you heard the information Television 2 about contraceptives? Peers 3 More than one answer is Teacher 4 possible Parents 5 Siblings 6 Health workers 7 Magazine 8 Newspaper 9 If other specify
11 Do you know where to get Yes 1 contraceptive methods if you want? No 2
12 What source of contraceptives Hospital /centers 1 do you know. Pharmacy/Chemical shop 2 More than one answer is Maternity home 3 possible Youth centres 4 Mothers 5 Friends 6 If any specify
III SEXUAL HISTORY
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13 Do you have sexual partner Yes 1
No 2 IF No 16
14 Have you ever had sexual Yes 1 intercourse? No 2 15 What is your age at first sex ……………………………………….
IV CONTRACEPTIVE USE
16 Have you ever used Yes 1 contraceptive methods? No 2 IF NO 23 17 Do you use contraceptive Yes 1 anytime you had sex No 2 18 What is your reason for using To prevent pregnancy 1 contraceptives To prevent only STDs 2 To prevent pregnancy and STDs 3 If others specify
19 Did you discuss about Yes 1 contraceptive methods the first No 2 time you had Do not remember 3 sex? 20 Did you use contraceptive the Yes 1 first time you No 2 had sex? Do not remember 3
21 What method did you or your Condom 1 partner used the first time you Pills 2 had sex? Injectable 3 Withdrawer 4 Safe period / calander method 5 If any specify
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22 Why did you used the method Easy for secret use 1 you used during the last Easy to get it 2 intercourse? Cheep to buy 3 I get it for free 4 Have better knowledge about it 5 If any specify
V. BARRIER TO CONTRACEPTIVE USE
24 What are the reasons why you Lack of knowledge 1 did not use any contraceptive Religious opposition 2 methods. Fear side effect 3 More than one answer is Afraid of being seen by possible parents 4 Partner disapproval 5 Do not know where to get contraceptive 6 I can’t afford to buy 7 Embarrassment to buy 8 Fear of bad health workers attitude 9 Fear of being seen by some one 10 who knows me Unavailability of contraceptives 11 Preferred source is far 12 Pressure from friends 13 Stigma of usage 14 Infrequent sex 15 If others specify
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DEBRIEF Thank you for taking part in this study. The study has now ended. Your participation is very much appreciated. We would like to take some time to provide you with a few more details concerning the study. Aim of the study The study aims to investigate knowledge and barriers to contraceptive use among in-school adolescents in Adaklu district. Contact Information If you have any questions or concerns regarding this project, please do not hesitate to contact the Ghana Health Service Ethical Review Committee Administrator on +233 507041223. Anonymity and Confidentiality we would like to remind you that your information will be anonymised and will remain completely confidential. It will be stored on an encrypted, password-protected computer and will only be used as part of a coursework assignment. Thank you again for your time.
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